Abstract
Background: Type 2 diabetes mellitus (T2DM) represents a significant global
health burden, with rising incidence rates in Thailand and substantial economic
consequences including escalated healthcare expenditures and reduced workforce
productivity. Despite the efficacy of current pharmacological interventions in glycemic
control, conventional treatment modalities have not achieved disease remission.
Objective: This study evaluated the effectiveness of a comprehensive Lifestyle
Medicine (LM) intervention program—emphasizing integrated lifestyle modification—
in inducing remission among non-insulin-dependent T2DM patients compared to
standard care over a six-month period.
Methods: A multi-center, real-world evidence-controlled trial was conducted
among patients with T2DM (diagnosed within the past six years) receiving care at
Ministry of Public Health hospitals in Thailand's Health Region 4. The study compared
remission rates and clinical outcomes between participants receiving the LM
intervention and those receiving standard care.
Results: The LM intervention achieved significantly higher remission rates than
control (15.1% vs. 4.0%, p < 0.001). Among 2,511 participants (17%), glucose-lowering
medications were successfully discontinued. The intervention group demonstrated
significant reductions in body mass index (p = 0.002) with mean HbA1c of 6.78 ± 1.22
and superior quality of life scores (EQ-5D: 0.95 ± 0.10 vs. 0.90 ± 0.24, p < 0.001). Renal
function remained comparable between groups, confirming program safety. Economic
analysis revealed medication cost reductions of 87,604,410 THB with net annual
economic benefits of 68,577,610 THB (4,287.44 THB per person per year).
Key Success Factors: (1) Patient empowerment through intrinsic motivation
and self-monitoring; (2) Healthcare team support utilizing motivational coaching and
timely counseling; and (3) Community-based sustained care facilitated by village
health volunteers, supported by regional health leadership.
Limitations: The six-month follow-up period may insufficient to assess longterm sustainability. Generalizability is limited to Health Region 4 and self-selected
participants. Certain real-world confounding variables could not be fully controlled.
Conclusions: The Lifestyle Medicine program demonstrated superior
effectiveness to standard care in achieving T2DM remission while maintaining safety,
improving quality of life, and demonstrating cost-effectiveness. Integration of patient
empowerment, healthcare team support, and community-based care proved essential
to success. This model is implementable within Thailand's health service system and
offers substantial potential for reducing the national burden of non-communicable
diseases. Recommendations include nationwide expansion, integration into national
health policy, and long-term follow-up studies (1–5 years) to establish outcome
sustainability.
